- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $112.97 / $164.14 / $342.93
| Facility | 26 | $112.97 | $164.14 | $342.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.23 / $371.26 / $681.11
| Professional | | $254.23 | $371.26 | $681.11 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $70.23 / $91.03 / $191.84
| Professional | 26 | $70.23 | $91.03 | $191.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $297.77 / $297.77 / $297.77
| Professional | | $297.77 | $297.77 | $297.77 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $64.42 / $80.86 / $139.88
| Professional | 26 | $64.42 | $80.86 | $139.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $265.52 / $303.45 / $379.33
| Professional | | $265.52 | $303.45 | $379.33 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $73.88 / $84.43 / $105.54
| Professional | 26 | $73.88 | $84.43 | $105.54 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $96.97 / $96.97 / $96.97
| Facility | 26 | $96.97 | $96.97 | $96.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.88 / $458.13 / $705.12
| Professional | | $249.88 | $458.13 | $705.12 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $61.93 / $102.14 / $182.17
| Professional | 26 | $61.93 | $102.14 | $182.17 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $792.40 / $792.40 / $792.40
| Facility | 26 | $792.40 | $792.40 | $792.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.45 / $428.40 / $2,854.54
| Professional | | $283.45 | $428.40 | $2,854.54 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.09 / $87.40 / $536.20
| Professional | 26 | $74.09 | $87.40 | $536.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.36 / $374.23 / $710.29
| Professional | | $282.36 | $374.23 | $710.29 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $74.09 / $79.41 / $165.60
| Professional | 26 | $74.09 | $79.41 | $165.60 |